摘要：
Objective To investigate the role of reflectance confocal microscopy (RCM),dermoscopy and VISIA skin detector in the efficacy evaluation of comprehensive treatment of melanosis.Methods Six patients with melanosis were treated with comprehensive therapy,which included avoiding sunlight exposure,sunscreen,moisturizing,intravenous drips of compound glycyrrhizin injection at a singledose of 40 ml once every 3 days for 8 sessions,oral tranexamic acid at a dose of 0.25 g twice a day,oral vitamin E at a dose of 60 mg/d,oral vitamin C at a dose of 0.1 g/d,self-made traditional Chinese medicine in the hospital,topical hydroquinone cream,asiaticoside ointment and levorotatory vitamin C serum.All patients were followed up once every 2 months for 12 months.RCM,dermoscopy and VISIA skin detector were performed in these patients before the treatment and during the follow-up.Statistical analysis was carried out to assess differences in VISIA indices before and after treatment using t test with the SPSS 19.0 software.Results After 12-month treatment,the skin lesions became ligher in color and and smaller in size.Before the treatment,RCM imaging showed disappearance of normal structure at the dermo-epidermaljunction and lots of highly refractive cells of various shapes,which were consistent with histopathological liquefaction degeneration in the basal layers.There were many mildly to moderately refractive round or oval cells in the superficial dermis,which were consistent with melanophages and lymphocytes in histopathology.After 12-month treatment,liquefaction degeneration and infiltration of inflammatory cells were both markedly improved.Before the treatment,dermoscopy showed gray-brown dots or small balls with a grid-like appearance,and indistinct blood vessel shadows.After 2-to 4-month treatment,the number of gray-brown dots or small balls obviously decreased,and linear,branched or reticular blood vessels can be observed.After 12-month treatment,there were no obvious dark brown dots/small balls or blood vessels by dermoscopy.The VISIA brown spot index and erythema index before the treatment were both significantly decreased compared with those after 12-month treatment (brown spot index:47.7 ± 0.9 vs.42.3 ± 0.4,t =6.740,P =0.001;erythema index:36.2 ± 2.1 vs.32.8 ± 1.4,t =6.69,P =0.001).Conclusion The comprehensive therapy of melanosis is effective.RCM,dermoscopy and VISIA skin detector can assist in the evaluation of curative effect on melanosis.%目的 探讨反射式共聚焦显微镜(RCM)、皮肤镜和VISIA皮肤检测仪在评估综合疗法治疗黑变病疗效中的作用.方法 收集2015年3月至2016年10月杭州市第三人民医院皮肤科黑变病患者6例,采用综合疗法治疗,即避光、防晒、保湿,静脉滴注复方甘草酸苷注射液40 ml/次,每3天1次,连续使用8次,口服氨甲环酸片0.25 g每日2次、维生素E 60 mg/d、维生素C 0.1 g/d、自制中药,外用氢醌乳膏、积雪苷霜软膏、左旋维C精华液.每2个月随访1次,随访12个月.治疗前及每次随访时均使用RCM、皮肤镜及VISIA皮肤检测仪检测.采用SPSS 19.0统计学软件,治疗前后指标比较采用t检验.结果 治疗12个月后,6例患者皮损颜色均变淡,面积变小.治疗前RCM表现为真表皮交界处正常结构消失,可见较多强折光形态各异的细胞,对应组织病理上基底层液化变性;真皮浅层有较多轻至中度折光的圆形/椭圆形细胞,对应组织病理上噬黑素细胞及淋巴细胞,治疗12个月后液化变性及炎症细胞浸润均明显改善.治疗前皮肤镜下可见灰褐色小点/小球,呈假网格状外观,隐约可见血管影,治疗2～4个月后灰褐色小点/小球明显减少,可见线状、分枝状或网状血管,治疗12个月后镜下未见明显灰褐色小点/小球及血管.VISIA棕色斑指数治疗前为47.7±0.9,治疗12个月后为42.3±0.4,治疗前后比较,t=6.740,P=0.001;VISIA红色区指数治疗前为36.2±2.1,治疗12个月后为32.8±1.4,治疗前后比较,t=6.69,P=0.001.结论 综合疗法治疗黑变病有效,RCM、皮肤镜和VISIA皮肤测试仪可辅助评估疗效.
